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W J Frable

Publications and source records attributed to W J Frable.

At least 37 records · Page 2Linked to original sources
PubMed1997

Spindle-cell lesions of the mediastinum: diagnosis by fine-needle aspiration biopsy.

Spindle cells seen in fine-needle aspiration biopsy (FNAB) of the mediastinal lesions can be a component of a wide variety of benign and malignant conditions. Few of these conditions, however, are described in the FNA cytopathology literature. This review discusses the cytopathologic features, differential diagnoses, and potential pitfalls of a variety of lesions with a significant component of spindle cells encountered in mediastinal FNAB. The cytopathology files from four institutions were searched for cases of mediastinal FNAB containing a spindle-cell component that was a key or predominant cytologic feature of the diagnostic specimen. The cytomorphologic features of these cases were analyzed, and their differential features are discussed. Of 196 mediastinal FNABs, 22 (11%) were lesions with significant spindle-cell component: granulomatous inflammation (four); benign nerve sheath tumor (four); thymic cyst (two); spindle-cell thymoma (two); large-cell non-Hodgkin's lymphoma with sclerosis (two); nodular sclerosing Hodgkin's disease (two); liposarcoma (two); spindle-cell squamous carcinoma possibly arising in a teratoma (one); unspecified high-grade sarcoma (one); spindle-cell malignant melanoma (one); and nonspecific fibrous tissue (one). The cytologic features of each lesion were analyzed as an aid for accurate classification. These findings were correlated with radiologic and clinical information when available. The value of ancillary studies performed on aspirated material in selected cases was also reviewed. FNA of mediastinal lesions with significant spindle-cell morphology represents an infrequent and heterogeneous group of entities that may pose significant diagnostic challenges. This review presents the salient cytopathologic features of various spindle-cell lesions of the mediastinum with particular emphasis on differential diagnosis and pitfalls. The pathologist must use caution when interpreting these lesions and ancillary studies may be of significant value in selected cases.

Adolescent↗
PubMed1997

"Litigation cells" in the Papanicolaou smear: extramural review of smears by "experts".

This paper presents a historical review of litigation involving false-negative Papanicolaou smears. The impact of the look back provision of the Clinical Laboratory Improvement Amendments of 1988 and the media attention focused on false-negative Papanicolaou smears is discussed. The problem types of cervicovaginal smears, including the categories of atypical squamous and/or glandular cells of undetermined significance, are also described.

Diagnostic Errors↗
PubMed1997

Does a zero error standard exist for the Papanicolaou smear? A pathologist's perspective.

A review of the error rate of cervicovaginal cytology in light of the increasing litigation over alleged misread Pap smears is presented. Public expectation for the eradication of death from carcinoma of the cervix has not been realized. The gap between that expectation and test performance of the Pap smear is examined historically and in light of current regulations that impact on cytology laboratories. It is imperative to educate the public as to the value and limitations of screening for cervical cancer by the Pap smear and to develop reasonable practitioner standards for the performance of the test. The current climate of increasing litigation over alleged false-negative Pap smears has the potential to reduce the use and availability of this test which is still considered the most effective cancer screening test devised.

Diagnostic Errors↗
PubMed1996

Adenoid basal carcinoma of the cervix: a potential pitfall in cervicovaginal cytology.

Adenoid basal carcinoma (ABC) of the cervix is a quite uncommon, indolent, yet invasive neoplasm rarely identified on cervicovaginal smears. This may be due in part to sampling. Unless ABCs become ulcerated, even vigorous brushing of the endocervical canal may not be adequate to dislodge the small, cohesive cells of this neoplasm. Fortunately, the association of ABC with squamous intraepithelial lesions (SIL) often results in its incidental diagnosis on follow-up cervical biopsy or endocervical curettage. We report two cases of ABC. In case 1, a 79-yr-old white woman was diagnosed with squamous-cell carcinoma on cervicovaginal (CV) smear. High-grade SIL, carcinoma in situ, and ABC were identified on subsequent cervical cone biopsy and hysterectomy. Retrospective evaluation of the CV smear revealed a few aggregates of small, uniform cells, with hyperchromatic nuclei representing fragments of ABC. In case 2, atypical basaloid cells suspicious for ABC were recognized on the CV smear of a 67-yr-old black woman, and ABC was subsequently confirmed on cervical cone biopsy. In neither case did the intervening cervical biopsy reveal ABC. In addition to a review of the clinical information useful in the diagnosis of ABC, the cytologic features of these two cases are compared with their subsequent histopathology and contrasted with other similar lesions comprising the differential diagnosis of small neoplastic cells found in cervicovaginal smears.

Aged↗
PubMed1996

Atypical reparative change on cervical/vaginal smears may be associated with dysplasia.

The Bethesda System for classifying cervical/vaginal smears has divided reparative changes into two categories: typical and atypical. Although atypical repair may be grouped with atypical squamous cells of unknown significance (ASCUS), this study selected cases specifically diagnosed as atypical reparative changes (ARC), which showed streaming sheets of cells and enlarged nuclei with nucleoli and anisonucleosis. Our goal was to determine the validity of grouping atypical repair with ASCUS. All cases were received by the Medical College of Virginia-Virginia Commonwealth University (MCV-VCU) pathology department in a 6-month period in 1993. Of 196 cases, 55 (28%) were biopsied within a subsequent 3-6-month period. Of these, 27 also carried a diagnosis of ASCUS (9), low-grade squamous intraepithelial lesion (LGSIL) (15), or high-grade squamous intraepithelial lesion (HGSIL) (3). The remaining 28 were presumably biopsied on the basis of clinical concern regarding a diagnosis of ARC. This group, which represents only 14% of the total with the ARC diagnosis, showed a spectrum of histologic changes from squamous metaplasia and chronic cervicitis to HGSIL. Surprisingly, 25% of these patients (7 of 28) showed changes of LGSIL or higher, including 2 (7%) showing HGSIL. This level of higher grade histologic findings justifies separation of atypical from typical repair. Although there are some cases with a significant histologic abnormality found with a cytologic diagnosis of ARC, the percentage of cases is not nearly as high as the 60% range seen associated with the diagnosis of ASCUS. Due to the lack of consensus on the clinical management of ASCUS, we find no justification to separate the diagnosis of ARC from that of ASCUS.

Biopsy↗
PubMed1996

Cytologic features of necrotizing granulomatous inflammation consistent with cat-scratch disease.

Approximately 2,000 cases of cat-scratch disease are reported annually. It is an uncommon cause of unilateral lymphadenopathy in children and adults. We present the cytologic features of necrotizing granulomatous lesions consistent with cat-scratch disease from various sites. Eleven cases from 10 patients with a mean age of 16 yr (range, 2-33 yr) were biopsied by fine-needle aspiration. All gave a history of previous exposure to cats. Two children had atypical presentations; one with multiple hypodense areas within the liver and spleen, and the other with features of encephalitis. Other locations included lymph nodes from axilla, inguinal, preauricular, and cervical areas, and other body sites such as the scapula and the parotid gland. Histologic staging of the inflammatory process was correlated with cytologic features. There were 5 cases of early features, 3 cases in the middle phase, and 3 cases in late stage. The differential diagnosis of each stage is discussed. The 2 children with atypical presentations are described in detail.

Adolescent↗
PubMed1996

Transitional-cell carcinoma metastatic to cerebrospinal fluid: presentation of two cases.

We present 11 specimens from 2 patients with transitional cell carcinoma metastatic to the cerebrospinal fluid. This is a rare occurrence documented in one previous report in which 5 patients had 28 specimens reviewed (Ehya et al., Acta Cytol 1981;25:599-610). Cytologic features that most likely indicate a bladder origin are the cytoplasmic tails and cytoplasmic pseudopod formation.

Carcinoma, Transitional Cell↗
PubMed1996

Complications of mastectomy and their relationship to biopsy technique.

BACKGROUND: Wound complication rates after mastectomy are associated with several factors, but little information is available correlating biopsy technique with the development of postmastectomy wound complications. Fine-needle aspiration (FNA) biopsy is an accurate method to establish a diagnosis, but it is unknown whether this approach has an impact on complications after mastectomy. METHODS: Charts of 283 patients undergoing 289 mastectomies were reviewed to investigate any association between biopsy technique and postmastectomy complications. RESULTS: The diagnosis of breast cancer was made by FNA biopsy in 50%, open biopsy in 49.7%, and core needle biopsy in 0.3%. The overall wound infection rate was 5.3% (14 of 266), but only 1.6% when FNA biopsy was used compared with 6.9% with open biopsy (p = 0.06). Among 43 patients undergoing breast reconstruction concomitantly with mastectomy, the infection rate was 7.1% (0% after FNA, 12% after open biopsy). Neither the development of a postoperative seroma (9.8%) nor skin flap necrosis (5.6%) was influenced by the biopsy technique used. CONCLUSIONS: These data suggest that wound infections after mastectomy may be reduced when the diagnosis of breast cancer is established by FNA biopsy.

Biopsy↗
PubMed1996

Fine-needle aspiration biopsy of the mediastinum. A multi-institutional analysis.

The combined experience of four university medical centers with fine-needle aspiration biopsy (FNAB) of the mediastinum is reviewed. This series includes 189 cases, with 100 males and 89 females, 6 months to 86 years of age. The majority (71%) of diagnoses were neoplastic with the remainder equally distributed between nondiagnostic/unsatisfactory and nonneoplastic lesions. Malignant lymphoma and thymoma were the most frequent primary malignancies. Metastatic tumors represented the majority (60%) of neoplasms identified by FNAB. In 16% of these cases, the primary tumor was not identified. The majority (67%) of metastases were from the lung and were predominantly small cell type (52%). Sixty-six ancillary tests were performed on 51 cases (27%). Histologic correlation was available in 78 of 189 (41%) cases, with a diagnostic sensitivity and specificity of 87% to 88% for the detection of neoplasm and 82% to 83% for distinguishing benign from malignant disease. The positive predictive value for the presence of neoplasm was 97% with three cytologic false positives identified. This series is the largest to date on the utility of FNAB for lesions of the mediastinum.

Adolescent↗
PubMed1996

PAPNET-directed rescreening of cervicovaginal smears: a study of 101 cases of atypical squamous cells of undetermined significance.

Many women having cervicovaginal smears interpreted as atypical squamous cells of undetermined significance (ASCUS) ultimately prove to harbor squamous intraepithelial lesions (SIL). The question is whether rare cells diagnostic of SIL are present in so-called "atypical" smears, but simply go undetected. To test whether the PAPNET Cytological Screening System, an automated system, can detect the (assumed) presence of such cells, six reviewers independently evaluated PAPNET video images generated for 101 cases conventionally diagnosed as ASCUS. Using PAPNET-identified microscopic coordinates, selected cases were then manually reviewed and reclassified according to consensus opinion. Overall, 35 cases were reclassified as SIL (22 low grade; 13 high grade). Histologic correlations showed 37 of the 101 cases conventionally interpreted as ASCUS carried tissue diagnoses of SIL, (28 low grade; 8 high grade, 1 ungraded). Using PAPNET, 24 of the 37 (65%) corresponding smears were reclassified as SIL (15 low grades; 9 high grade).

Diagnosis, Computer-Assisted↗
PubMed1996

Solitary splenic metastasis of an adenocarcinoma of the ovaries.

Metastatic involvement of the spleen by carcinoma occurs in a setting of widespread malignant disease. Solitary splenic metastasis in the absence of disseminated disease is rare. We report a case of a 55-year-old woman in whom the sole clinical manifestation of recurrent papillary serous cystadenocarcinoma of the ovary was an elevated serum CA125 level due to a solitary splenic metastasis.

Biomarkers, Tumor↗
PubMed1995

Fine-needle aspiration cytopathology of soft tissue: chondromyxoid and myxoid lesions.

Soft-tissue lesions pose an intimidating challenge to diagnostic interpretation by fine-needle aspiration cytology. To better characterize such aspirates, we investigated a subgroup of lesions which yielded a large amount of chondromyxoid and myxoid stroma (CMS). Thirty-three cases (22 malignant lesions, 11 benign lesions) in which CMS was a prominent feature of the smears were studied. The most common malignant neoplasms were extraskeletal chondrosarcoma (6 cases), myxoid liposarcoma (6), and malignant fibrous histiocytoma (5). The benign entities consisted of ganglion cyst (4), myxoma (3), and neurofibroma (2). Of the aspirates from 22 malignant neoplasms, 15 (68%) contained opaque stroma, and in 18 (81%) the stroma was distributed as discrete clumps or fragments; all extraskeletal chondrosarcomas and chordomas contained these features. Additionally, in five of six chondrosarcomas the matrix exhibited cells within lacunae. Except for a tracheal chondroma which extended into the adjacent soft tissue, no benign aspirates had all three of these cytologic features. Twenty-three aspirates (70%) were moderately or highly cellular; all but two of these were malignant. Moderate to marked nuclear atypia occurred in 13/22 (59%) malignant and 1/11 (9.0%) benign aspirates. With a few exceptions, aspiration smears of benign lesions with abundant CMS were characterized by low cellularity, semitransparent amorphous stroma, and lack of nuclear irregularity. Recognition of variations in the character of the background material in addition to traditional cytologic criteria can aid in the diagnosis of benign and malignant chondromyxoid and myxoid aspirates of soft tissue.

Adolescent↗
PubMed1995

Fine-needle aspiration biopsy and imprint cytology of small non-cleaved cell (Burkitt's) lymphoma.

We reviewed 13 cases of small non-cleaved cell (Burkitt's) lymphoma diagnosed by fine-needle aspiration biopsy (FNAB) and four cases where that diagnosis was made from touch imprints from surgical biopsy specimens. The most common site was intraabdominal. Histologic confirmation was present in 14/17 cases. General microscopic features on smears included high cellularity and an individual cell pattern. Extracellular lymphoglandular bodies were abundant and tingible body macrophages were prominent. Nuclei were intermediate in size and round with a finely dispersed chromatin pattern on May-Grünwald-Giemsa stained smears. Cytoplasm was basophilic and scant with prominent vacuoles. Extracellular vacuoles and vacuoles within lymphoglandular bodies occurred in all patients. Immunocytochemistry performed on 16/17 cases demonstrated a B cell phenotype in 15. Nine cases were kappa light chain positive and six were lambda light chain positive. Flow cytometry performed in five cases demonstrated diploid cells with a high S phase. We conclude that Burkitt's lymphoma can be diagnosed using combined FNAB and immunophenotyping.

Adolescent↗